Wednesday, March 3, 2010

teach ALL kids how to eat

In spite of what all the press around Michele Obama's "childhood obesity" campaign might lead you to believe, we are not merely facing a “childhood obesity crisis,” we are facing a crisis in feeding our children.

•only one in ten teenagers gets close to the recommended fruit and vegetable intake

• 2 out of 3 teenage girls are dieting

•dieting is a predictor of weight gain and depression and is often a trigger for devastating eating disorders

•even “healthy” dieters are heavier and have more disordered eating than non-dieters

• almost half of teenage girls use extreme dieting measures such as laxative abuse,vomiting or crash fasting

• 20% of kids have “feeding disorders” that impair growth and development (according to Kennedy-Krieger researcher)

•80% of kids with developmental problems have feeding problems

•there is an increase in diagnoses of eating disorders at ever younger ages

• 80% of "obese" adults were not "obese" as children. Even if you believe that weight on its own predicts health care costs (a point of significant debate,) the current approach of targeting "fat" children will fail to control future costs as it gives today's "normal" and "underweight" kids a pass-and they don't know how to eat either.

So true! We want all children to be all that they can be. Research demonstrates that children who are labeled overweight feel flawed in ALL ways. There is no evidence that labeling children overweight leads to reduced weight. So, what is the utility in continuing to focus on obesity?

And, as you so point out so well, all children need our support, not just children of size.

I am totally with you. ALL children need our support, not just children of size. Research demonstrates that children labeled as overweight feel flawed in ALL ways, and research also demonstrates that labeling children as overweight fails to produce significant weight outcomes. So what is the utility of focusing on overweight?

Melonie, I am with you as well about separating size and behavior. We know that people can be fit and fat. People can also be thin and not fit.

So... I prefer Ellyn Satter's focus on providing instead of depriving, being all we can be while we help our children do the same.

I think the majority of your points has less to do with our kids not knowing "how to eat," but rather, being told that being/not being a particular body shape/size is more important than eating normally and intuitively.

I think kids know how to eat, as it were, in larger number than adults. With the exception of more veggies (which I'm really not sure about, actually), if the diet culture was subverted most of the points you mentioned above would cease to be relevant.

The focus shouldn't be on admonishing parents or pouring more money into food education. The focus should be on eradicating the obsession with thin, or focusing education on the facts of body size in the already-existing health classes (largely genetic, different bodies metabolize different food differently, teenage bodies change drastically and one should embrace the change, not fear it, etc).

But I suppose this wouldn't have as much support as generating fear and loathing of fat kids, which most anti- childhood obesity 'measures' are all about.

Can I ask about this statistic? "80% of kids with developmental problems have feeding problems"

A long time ago, I read that some sorts of junk food can exacerbate developmental problems in children. From limited experience, I've seen that some kids with problems actively prefer junk over other food (to the exclusion of whole food categories). Is that part of the "80% feeding problem"?

melonie,Many sources are Neumark-Sztainer, Children and Teens Afraid to Eat, Frances Berg, Kennedy Krieger Institute, and more. If you want the specific sources, please email me and I'll get them to you! I'd love to learn about what your dissertation is.katja@familyfeedingdynamics.com

Melonie, Clio and Bigliberty (sorry for slow response, I had my eyes dilated this morning and it's not fun!) Focusing in behavior will help. As a doctor, I saw kids who were gaining weight very rapidly in a way that was not healthy for that individual. The traditional approach did not work. If I had been able to focus on his behavior I think it would have helped him eat and grow in a way that was healthy for him. (For example, was he eating breakfast, did snacks have enough calories, protein, fat and carb to satisfy...) Focusing on weight as the measure of positive health was wrong and counterproductive. Bigliberty, I agree. Kids come into the world knowing how much they need, BUT they also need support. They need their care providers to provide a variety of foods (including "forbidden" foods) with structure in a pleasant setting. I totally agree that the thin ideal is a major contributor to many of the points I mentioned, but not the only one. Parents also now are scared about "nutrition" and just don't know the basics about feeding. Kids are fed for behavior control, because they're bored, or for entertainment. Kids need to be supported with structure and allowed to decide how much they eat at those opportunities. I will tell you that talking with hundreds of moms mostly, there is a TON of confusion about normal growth (including a variety of shapes) but also normal development and parenting skills. It's complicated, but expecting everyone has to be "thin" to be healthy is a huge contributor. Thanks!

Alice, great question. there is a lot of uncertainty right now in this area. A February ADA review on Autism Spectrum and Feeding basically said, "We don't know and we need more research..." There is some indication that some kids are more sensitive to food additives in terms of behavior. The "sugar" high that many people believe in may also be a sugar "crash" when blood sugar drops rapidly because there is no protein or fat ingested with the simple sugar load. By report, extreme pickiness seems to be more of a problem with ASD, but I tend to think it's likely a combination of factors. There is more "sensory integration" problems with ASD, which means a child may be more particular and reject foods more readily due to texture, smell and visual cues. This means that a "normal" child might need 10 exposures to a food, where a child with SI might need many times more. Other thoughts 1) extreme pickiness means probably nutritional deficiencies (kids who only eat one brand of nugget and a french toast product for example) 2) behavior challenges effect feeding. ASD kids tend to swing from extremes more quickly with a narrower emotional window of calm-perhaps leading to parents being more willing to only offer preferred foods.3)"developmental disabilities" likely also includes kids with cerebral palsy, swallowing mechanical problems, history of a feeding tube, medications complicating hunger etc.I believe the source for this was a feeding clinic researcher where the percentage may be overestimated, but the number is still very high.

I'm glad that I clicked on your obesity tab on the side. I was thinking you didn't understand anything about what the real problem was after reading your most recent obesity post, but apparently you do. Kudos.

What would you like to see more of on the FFD blog?

Katja Rowell MD

click for website

Helping raise children with a healthy relationship to food and their bodies. Katja is a member of the clinical faculty with the Ellyn Satter Institute. She works with families struggling with feeding to bring peace and joy back to the family table.